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Expert Commentary: Regulatory Issues Attach and conquer

Four reasons why implementing a strategy for 275 compliance can drive cost savings this year.

T By Thomas W. Hughes

oday, the secretary of Health and Human Services has the 275 mandate on her desk, ready to be signed. The question is not if, but when these requirements will be enacted. So what does this mean for healthcare providers and claims processing? With 275, payers would be required to accept six medical electronic attachments in a standardized for- mat. The six standardized attachments include lab, ambulance, emergency department, rehabilitation, clinical and medication reports. For many, more red tape and mandates from the government can create frustration and headache. But this mandate is decidedly different. The implication of requiring standardized at- tachments lends itself well to establishing protocols for electronic attachment submission. By making this submission process available, providers will be able to submit their attach-

Thomas Hughes is founder and CEO, Medical Electronic Attachment.

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ments in less time with the initial claim submission. They will avoid the cost of postage and the risk of lost attachments. Submitting attachments electronically will also enable providers to receive reimbursements more quickly and eliminate time on the phone with the payer’s help desk, tracking down lost attachments. In short, by getting onboard with the 275 require- ments now, payers and providers can not only obtain compliance for the future, but also positively affect the bottom line. There are four specifi c objectives that can be achieved:

Save time and increase capacity for claims submission

Every day that a claim goes unpaid, money is lost. By utilizing an electronic attachment process with standards-based formatting, providers will reduce the amount of time it takes the payer to adjudicate claims, decreasing reimbursement time almost immediately. Additionally, the amount of claims that an insurance reviewer can process in a day is restricted by the use of paper and other attachments. Increasingly, busi-

14 January 2011

ness models call for an increase in revenue streams through additional services and service lines available to patients; it logically follows that operational costs will also increase. By utilizing electronic claims and implementing an electronic attachment solution, the number of claims each team can submit without in- creasing head count or staff will increase.

Eliminate lost attachments Paper gets lost, period. Whether it is held up with the postal service, sits on someone’s desk or is fi led in the wrong place, paper attachments have a way of not making it to the claims reviewer. The result is more than just the hassle of resubmissions due to lost attachments – it costs money. Delays in payment – as well as administrative costs to copy, process and mail a second request – add up fast. Keep staff focused on fi ling new claims, not tracking lost items with the insurance companies.

Get paid faster

Because patient information is automatically fi led away in a digital format, it only takes a few clicks of the mouse to include the electronic attachment ID in the PWK segment of the 837 fi le. Comparatively, printing attachments and mailing them takes time to prepare. Attachments spend days in the mail system and then they must be opened, indexed, sorted and then en-


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